Near-infrared spectroscopy in the medical management of infants
Bailey, Sean M; Prakash, Shrawani Soorneela; Verma, Sourabh; Desai, Purnahamsi; Kazmi, Sadaf; Mally, Pradeep V
Near-infrared spectroscopy (NIRS) is a technology that is easy to use and can provide helpful information about organ oxygenation and perfusion by measuring regional tissue oxygen saturation (rSO2) with near-infrared light. The sensors can be placed in different anatomical locations to monitor rSO2 levels in several organs. While NIRS is not without limitations, this equipment is now becoming increasingly integrated into modern healthcare practice with the goal of achieving better outcomes for patients. It can be particularly applicable in the monitoring of pediatric patients because of their size, and especially so in infant patients. Infants are ideal for NIRS monitoring as nearly all of their vital organs lie near the skin surface which near-infrared light penetrates through. In addition, infants are a difficult population to evaluate with traditional invasive monitoring techniques that normally rely on the use of larger catheters and maintaining vascular access. Pediatric clinicians can observe rSO2 values in order to gain insight about tissue perfusion, oxygenation, and the metabolic status of their patients. In this way, NIRS can be used in a non-invasive manner to either continuously or periodically check rSO2. Because of these attributes and capabilities, NIRS can be used in various pediatric inpatient settings and on a variety of patients who require monitoring. The primary objective of this review is to provide pediatric clinicians with a general understanding of how NIRS works, to discuss how it currently is being studied and employed, and how NIRS could be increasingly used in the near future, all with a focus on infant management.
Impact on neonatal morbidities after a change in policy to administer antenatal corticosteroids to mothers at risk for late preterm delivery
Mally, Pradeep; Katz, Julia; Verma, Sourabh; Purrier, Sheryl; Wachtel, Elena V; Trillo, Rebecca; Bhutada, Kiran; Bailey, Sean M
OBJECTIVES/OBJECTIVE:Antenatal corticosteroids (ACS) administered to mothers at risk for preterm delivery before 34Â weeks has been standard care to improve neonatal outcomes. After introducing a new obstetric policy based on updated recommendations advising the administration of ACS to pregnant women at risk for late preterm (LPT) delivery (34-36 6/7Â weeks), we set out to determine the short-term clinical impact on those LPT neonates. METHODS:Retrospective chart review of LPT neonates delivered at NYU Langone Medical Center both oneÂ year before and after the policy went into place. We excluded subjects born to mothers with pre-gestational diabetes, multiple gestations, and those with congenital/genetic abnormalities. We also excluded subjects whose mothers already received ACS previously in pregnancy. Subjects were divided into pre-policy and post-policy groups. Neonatal and maternal data were compared for both groups. RESULTS:388 subjects; 180 in the pre-policy and 208 in the post-policy group. This policy change resulted in a significant increase in ACS administration to mothers who delivered LPT neonates (67.3 vs. 20.6%, p<0.001). In turn, there was a significant reduction in LPT neonatal intensive care unit (NICU) admissions (44.2 vs. 54.4%, p=0.04) and need for respiratory support (27.9 vs. 42.8%, p<0.01). However, we also found an increased incidence of hypoglycemia (49.5 vs. 28.3%, p<0.001). CONCLUSIONS:This LPT ACS policy appears effective in reducing the need for LPT NICU level care overall. However, clinicians must be attentive to monitor for adverse effects like hypoglycemia, and there remains a need for better understanding of potential long-term impacts.
Visitor restriction during the COVID-19 pandemic did not impact rates of Staphylococcus aureus colonization in the NICU patients
Evans, Hailey Zie; Bailey, Sean; Verma, Sourabh; Cicalese, Erin
OBJECTIVES/OBJECTIVE:colonization rates before and after the visitor policy change, which coincided with the exponential riseÂ of COVID-19 cases in New York City (NYC). METHODS:colonization. RESULTS:=0.02). CONCLUSIONS:colonization rate. Hospital unit leaders may need to focusÂ on other strategies in order to reduce colonization.
Effects of Inhaled Iloprost for the Management of Persistent Pulmonary Hypertension of the Newborn
Verma, Sourabh; Lumba, Rishi; Kazmi, Sadaf H; Vaz, Michelle J; Prakash, Shrawani Soorneela; Bailey, Sean M; Mally, Pradeep V; Randis, Tara M
OBJECTIVE:â€ƒThe study aimed to evaluate the effects of inhaled iloprost on oxygenation indices in neonates with persistent pulmonary hypertension of the newborn (PPHN). STUDY DESIGN/METHODS:) were recorded. RESULTS:â€‰<â€‰0.05), with no significant change in required mean airway pressure over that same period. There was no change in vasopressor use or clinically significant worsening of platelets count, liver, and kidney functions after initiating iloprost. CONCLUSION/CONCLUSIONS:â€ƒInhaled iloprost is well tolerated and seems to have beneficial effects in improving oxygenation indices in neonates with PPHN who do not respond to iNO. There is a need of well-designed prospective trials to further ascertain the benefits of using inhaled iloprost as an adjunct treatment in neonates with PPHN who do not respond to iNO alone. KEY POINTS/CONCLUSIONS:Â· Inhaled iloprost seems to have beneficial effects in improving oxygenation indices in PPHN.. Â· Inhaled iloprost is generally well tolerated in newborns with PPHN.. Â· There is a need for prospective RCTs to further ascertain the benefits of using inhaled iloprost..
Identification and Treatment of Neonatal Seizures During Therapeutic Hypothermia and Rewarming
Verma, Sourabh; Bailey, Sean M; Mally, Pradeep V
Outcomes of Maternal-Newborn Dyads After Maternal SARS-CoV-2
Verma, Sourabh; Bradshaw, Chanda; Auyeung, N S Freda; Lumba, Rishi; Farkas, Jonathan S; Sweeney, Nicole B; Wachtel, Elena V; Bailey, Sean M; Noor, Asif; Kunjumon, Bgee; Cicalese, Erin; Hate, Rahul; Lighter, Jennifer L; Alessi, Samantha; Schweizer, William E; Hanna, Nazeeh; Roman, Ashley S; Dreyer, Benard; Mally, Pradeep V
Performance of common health literacy measures in younger adult parents [Meeting Abstract]
Batio, S; Arvanitis, M; Curtis, L M; Bailey, S; Wolf, M S; Yin, S
BACKGROUND: Nearly one third of US parents have limited health literacy, therefore lacking the full capability of making appropriate health decisions for themselves, and for their children. Despite the importance of addressing parent health literacy, the most commonly used health literacy instruments utilized in research were developed and validated in older adult populations, and may have reduced discriminative predictive validity in younger adults (40 years old and younger). As part of a larger controlled study of pediatric liquid medication dosing, we examined the performance of three health literacy measures, BHLS (Brief Health Literacy Screen), S-TOFHLA (Short Test of Functional Health Literacy in Adults) and NVS (Newest Vital Sign) in a diverse, younger parent population.
METHOD(S): We used data from a randomized controlled study of strategies to improve medication label and dosing tools, and reduce parental error in dosing liquid medicines. Parents and legal guardians, 18 years or older, were recruited in pediatric outpatient clinics in New York, NY, Atherton, CA and Atlanta, Georgia. Parents were eligible if they identified as caregivers for their child of 8 years or younger. Kappa statistics were used to assess the agreement between BHLS, S-TOFHLA and NVS. Multivariate logistic regressions were performed to assess the associations between these health literacy measures and making a medication dosing error (>20% deviation from correct dose). Additionally, ROC curves and contrasts were used to compare the predictive validity of these measures.
RESULT(S): Of the 1,956 parents, 92% were mothers of young children, with a mean age of 28. Over half of the parents identified as Hispanic, and nearly one-third reported low English proficiency and grade school as their highest educational attainment. According to the BHLS, 98% self-identified as having adequate health literacy, whereas, 85% of them were classified as having adequate health literacy by S-TOFHLA and only 23% by the NVS measure. Weak agreements between NVS and S-TOFHLA (kappa=0.13; 95%CI:0.11-0.14), and NVS and BHLS (kappa=0.03; 95% CI:0.0048- 0.02) were observed. Adequate health literacy, by all the measures, was associated with lower probability of making a dosing error (BHLS: aOR=0.52, p<0.001; S-TOFHLA: aOR=0.47, p<0.001; NVS: aOR=0.53, p<0.001). However, ROC contrasts estimates show significant differences between the predictive validity of BHLS and NVS (-0.01; p<0.001), and STOFHLA and BHLS (0.01; p<0.001). The ROC contrasts showed no significant differences between S-TOFHLA and NVS (-0.003; p=0.36).
CONCLUSION(S): Our analysis found the BHLS and S-TOFHLA to be poor assessments of health literacy with significant ceiling effects when administered to a younger, ethnically diverse, primarily female, adult parent population. The NVS, an objective health literacy measure, may perform better in younger adults than subjective measures such as BHLS, and measures with questionable discriminative and predictive validity, such as S-TOFHLA
Neonatal Intensive Care Unit Preparedness for the Novel Coronavirus Disease-2019 Pandemic: A New York City Hospital Perspective
Verma, Sourabh; Lumba, Rishi; Lighter, Jennifer L; Bailey, Sean M; Wachtel, Elena V; Kunjumon, Bgee; Alessi, Samantha; Mally, Pradeep V
In January 2020, China reported a cluster of cases of pneumonia associated with a novel pathogenic coronavirus provisionally named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). Since then, Coronavirus Disease 2019 (COVID-19) has been reported in more than 180 countries with approximately 3 million known infections and more than 210,000 deaths attributed to this disease. The majority of confirmed COVID-19 cases have been reported in adults, especially older individuals with co-morbidities. Children have had a relatively lower rate and a less serious course of infection as reported in the literature to date. One of the most vulnerable pediatric patient populations is cared for in the neonatal intensive care unit. There is limited data on the effect of COVID-19 in fetal life, and among neonates after birth. Therefore there is an urgent need for proactive preparation, and planning to combat COVID-19, as well as to safeguard patients, their families, and healthcare personnel. This review article is based on the Centers for Disease Control and Prevention's (CDC) current recommendations for COVID-19 and its adaptation to our local resources. The aim of this article is to provide basic consolidated guidance and checklists to clinicians in the neonatal intensive care units in key aspects of preparation needed to counter exposure or infection with COVID-19. We anticipate that CDC will continue to update their guidelines regarding COVID-19 as the situation evolves, and we recommend monitoring CDC's updates for the most current information.
The value of routine laboratory screening in the neonatal intensive care unit
Kazmi, S H; Caprio, M; Boolchandani, H; Mally, P; Bailey, S; Desai, P
BACKGROUND:Healthcare spending is expected to grow faster than the economy over the next decade, and the cost of prematurity increases annually. The aim of this study was to investigate the frequency of intervention after routine laboratory testing in preterm infants. METHODS:This was a retrospective study of preterm infants (â‰¤34 weeks) admitted to the NYU Langone Health NICU from June 2013 to December 2014. Data collected included demographics, results of laboratory tests, and resulting interventions. Intervention after a hemogram was defined as a blood transfusion. Intervention after a hepatic panel was defined as initiation or termination of ursodiol or change in dose of vitamin D. Subjects were stratified into 3 groups based on gestation (<28 weeks, 28-31 6/7 weeks, 32-34 weeks). Chi-square analysis was used to compare the frequency of intervention between the groups. RESULTS:A total of 135 subjects were included in the study. The frequency of intervention after a hemogram was 8.4% in infants <28 weeks, 4.6% in infants 28-31 6/7 weeks, and 0% in infants 32-34 weeks; this difference was found to be statistically significant (pâ€Š=â€Š0.02). The frequency of intervention after a hepatic panel was 4.2% in infants <28 weeks, 5.7% in infants 28-31 6/7 weeks, and 0% in infants 32-34 weeks, which was not found to be a statistically significant different. CONCLUSION/CONCLUSIONS:No interventions were undertaken post-routine laboratory testing in any infant 32-34 weeks and routine testing in this population may be unnecessary. Further studies are needed to elucidate if routine testing affects neonatal outcomes.
Electrical Activity of the Diaphragm in a Small Cohort of Preterm Infants on Noninvasive Neurally Adjusted Ventilatory Assist and Continuous Positive Airway Pressure: A Prospective Comparative Pilot Study
Gupta, Arpit; Lumba, Rishi; Bailey, Sean; Verma, Sourabh; Patil, Uday; Mally, Pradeep
OBJECTIVE:To compare the electrical activity of the diaphragm (Edi) of premature infants placed on continuous positive airway pressure (CPAP) with the Edi of premature infants placed on noninvasive neurally adjusted ventilatory assist (NIV NAVA). The secondary aim was to evaluate the feasibility of the use of NIV NAVA mode in the busy tertiary neonatal unit. STUDY DESIGN/METHODS:This was a prospective crossover pilot study of premature infants requiring noninvasive respiratory support. Infants were randomized to initially receive either CPAP/biphasic (group 1) or NIV NAVA (group 2) and were then crossed over to the alternate group. Continuous Edi signals were recorded for 24 h, with 12 h each on CPAP/biphasic, and NIV NAVA along with other clinical and respiratory parameters.Â Results: Ten infants with a mean gestation age of 29 weeks (range 25-34 weeks) were enrolled, with a total cumulative Edi monitoring of 240 h. The average Edi peak on the biphasic/CPAP group (15.6 Â± 7 mcV) was significantly higher (P < 0.005), compared to the Edi Peak on the NIV NAVA group (10.8 Â± 3.3 mcV). The Edi min values were 3.23 Â± 1.1 mcV, and 3.07 Â± 0.5 mcV on CPAP/biphasic and NIV NAVA (P = 0.69) respectively. There were no significant differences in other clinical parameters between the two groups. No major adverse events were recorded during Edi catheter monitoring. CONCLUSION/CONCLUSIONS:The Edi peak values were significantly lower in NIV NAVA mode compared to CPAP/biphasic mode. The Edi catheter and NIV NAVA may also be used safely in premature infants.